MEDICARE: MRS. GINA RENEE MOORE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WH0200X	Home Health Registered Nurse	011073	TX

General Provider Information

NPI Number	:	1639364730
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA RENEE MOORE

Provider Business Mailing Address
First Line	:	7303 LAS BRISAS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-4325
Country	:	US
Telephone Number	:	281-495-2937
Fax Number	:	281-879-7937

Provider Business Practice Location Address
First Line	:	7303 LAS BRISAS DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77083-4325
Country	:	US
Telephone Number	:	281-495-2937
Fax Number	:	281-879-7937

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/11/2007
Last Update Date	:	09/11/2007

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